In surgical procedures, retractors are used to retract tissue in an incision, and thereby open the incision for use in carrying out the surgical procedure. Leverage retractors that use a fulcrum around a tissue structure (typically, bone) or that create a fulcrum by placing the tip of the retractor into the bone are vital and commonly used in surgery in general, and in orthopedic surgery in particular. Retractors that are fairly straight can be driven into the bone or through a soft-tissue interval by using a mallet to impact the retractor into the desired location. Curved or bent retractors, on the other hand, are preferred for many procedures because the handle end of the retractor can be placed farther from the incision, which provides a better lever-arm and keeps hands or holders farther from the incision and sharp instruments. Curved or bent retractors are also less likely to obstruct the surgeon's view during surgery. Unfortunately, bent retractors are difficult to impact because the impacting the end of the retractor creates a force in the wrong direction.
Impactors are commonly used in surgical procedures to transfer an impaction force to a particular instrument or implant. For example, in hip arthroplasty, impactors are used to impact acetabular shells into a prepared acetabulum. In the past, bent retractors have been designed with a fenestration near the working tip of the retractor so that a retractor-impactor can be placed in the fenestration such that the use of a mallet will provide a force in the correct direction for retractor impaction. Unfortunately, these retractor-impactor combinations are awkward to use since they require three hands to manage: one to control the impactor; one to control the retractor; and one to control the mallet.
In recent years, efforts have been made to develop instruments and procedures for use in minimally invasive surgery, and minimally invasive hip and knee arthroplasty in particular. In minimally invasive surgery (“MIS”), the operation is carried out through a small incision, such as an 8 cm incision, for example. MIS procedures may reduce trauma to the patient's muscles and other tissues, and typically result in shorter patient recovery time. However, operating in the confines of a small incision presents challenges to the surgeon. The surgeon must often rely on specialized surgical instruments in order to access or operate within the surgical site. While performing MIS hip procedures, the inventor, who is an experienced orthopedic surgeon, discovered the need for a retractor of the type described herein.